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Application Packet 2009-2010

General Instructions Submit the Following:  Application for admission. Print or type in English and answer all questions. International applications are online at  Non-refundable application fee of $100 made payable to WWCC (Visa or MasterCard accepted).  Official high school and any college transcripts (if transfer equivalency is requested) translated to English. Attested copies are accepted.  WWCC requires documentation of English ability: 1. Official SAT score report or TOEFL score of 500 regular / 173 computer / 61 iBT or STEP Eiken Grade 2A or Cambridge ESOL exam or IELTS 5 for regular course enrollment. 2. Official TOEFL score of 400 regular / 97 computer / 32 iBT or STEP Eiken Grade Pre-2 or Cambridge ESOL exam or IELTS 4 for ESL course enrollment.  Request official SAT scores (if any) be sent to WWCC. SAT scores are not needed for admission, but are required for academic scholarship consideration and may be considered as documentation of English ability. WWCC's school code is 4957.  Financial statement with signed statement from the student's or guarantor’s bank stating applicant has available a minimum of $15,000 to cover first year costs, travel and personal expenses.  Health statement with a physician’s signature and verification of inoculation for MMR (Measles, Mumps and Rubella) (submit note from physician or copy of inoculation card).  Photocopy of the passport page which lists the student's full name. Additional Requirement:  All international students must have medical insurance. Proof of international medical coverage or the College's insurance is required. College insurance is included in the international student deposit.

Applying for Housing:  Complete the admission process to WWCC. No one is assigned to housing until they have been accepted for admission.  Complete the housing application. Applications are online at  Submit $150 housing deposit made payable to WWCC ($25 is non-refundable as a processing fee).  When all requirements are met, a room assignment will be made, and the student will be issued a housing contract. The reservation is not complete until the signed contract is received by the Housing Office. Housing assignments for Fall (August) are made after May 1.

Admissions Deadlines:  June 15 for Fall (August) semester  November 1 for Spring (January) semester

Application for Admission Instructions:  Print or type in English. Answer all questions. You may complete and submit the application online at  Sign the form. If under 21, a parent or legal guardian must also sign this form.  Obtain a check or money order payable to WWCC for $100 US currency (non-refundable application fee). Visa or MasterCard accepted.  Mail to: Western Wyoming Community College Admissions 2500 College Drive Rock Springs, WY 82901 USA Program of Study:

 English as a Second Language (ESL)

 ESL followed by regular college program _ Regular College Program

Country of Birth:_______________________________________________

Legal Name: Last (Family) _ _______________________________________________

Country of Citizenship:_ ________________________________________

First (Given)_________________________________________________

Native Language:______________________________________________

Middle_ ____________________________________________________


Former Name(s)______________________________________________ Official Name on Passport:_______________________________________ Permanent Mailing Address: (where your permanent home is located, cannot be the residence halls)

Name______________________________________________________ Street Address_ _____________________________________________ P.O. Box (if any)______________________________________________ City _________________________________________________

Street Address_________________________________________________

State ________________________________________________

P.O. Box (if any)_ _______________________________________________

Country ____________________________________________________


Postal Code_________________________________________________

State _________________________________________________________

Phone_ ____________________________________________________


Relationship_ _______________________________________________

Postal Code_ __________________________________________________ Permanent Phone Number: _____________________________________ Cell Phone Number: _ __________________________________________ Email Address: ________________________________________________

Emergency Contact: Name______________________________________________________ Address____________________________________________________ ___________________________________________________________ Phone_ ____________________________________________________

Enrollment Information Planned Semester and Year of Enrollment:  Fall (August) 20_____  Spring (January) 20_____ Status: (Check all that apply)  New Freshman, no previous college attendance  Transfer student, list all colleges previously attended and location__________________________________________________________ _________________________________________________________________________________________________________________


Previous WWCC Student

Dates attended___________________________ Names attended under____________________________________

Non-Refundable Application Fee of $100 + Housing Deposit $150 ($125 refundable) for a total of $250 (Visa or MasterCard accepted). Our Business Office is unable to process credit card payments without complete information Payment: q Visa q MasterCard q Bank Draft q Money Order q Wire Transfer Credit Card Number ___________________________________________ Expiration Date: ___________________ (Month/Year) Full name as shown on the card: __________________________________________________ Complete Cardholder Billing Address: Street Address: ____________________________________________ P.O. Box (if any) ____________________ City: _________________________________ State: ______________________ Country: _______________________________ Postal Code: ______________________ ADM 07/09

Application continued on reverse side.

High School:   High School Graduate   No High School Graduation

Name of High School:_________________________________________ City, Country:_________________________________________

Graduation Date:____________ Month/Year

Primary Reason for Enrollment:  Degree Seeking (taking courses to receive a degree and transfer to a 4 year institution)  Degree Seeking (taking courses to receive a degree and go to work in my field)  Certificate Seeking (taking courses to receive a certificate and go to work in my field)  Taking Courses for Transfer, Not Degree Seeking  Upgrade Current Job Skills or Retraining  Develop New Job Skills  Teacher Recertification  Personal Enrichment or Exploration  English as Second Language Planned College Major (See list below):_________________________________ Are you planning to live on campus?



Demographic Information This information is gathered for reporting and recordkeeping. The responses to these questions will have nothing to do with the admission decision. Gender:

 Male

 Female


Month_ ________

/  Day___________

/  Year_ __________

Marital Status:  Married  Single  Divorced  Widowed *If your spouse or children will accompany you, please submit complete names, birth dates and passport photocopies. Ethnic status:  Black  Hispanic

 American Indian, Alaskan  Asian

 Hawaiian/Pacific Islander  White

 Non-Resident Alien

Do you give WWCC permission to use the following as directory information and release it upon request? Items such as name, address, telephone, email address, birthdate, field of study, enrollment status, degrees, photographs, and awards.  Yes   No I give WWCC permission to use photos and quotes from me in promotional materials.

 Yes   No

I declare under the penalty of perjury that the information furnished is, to the best of my knowledge and belief, true, correct, and complete. Applicant’s Signature_ _______________________________________________________________

Date_ ________________________

Transfer Programs Business Accounting Business Administration Computer Science Economics Marketing Fine Arts Art Ceramics Dance Music Musical Theatre Technical Theatre Theatre Visual Art 2D

Health Science Exercise Science Nursing Pre-Dental Hygiene Pre-Medicine Pre-Pharmacy Pre-Physical Therapy Pre-Radiologic Technology Humanities Communication English Journalism Spanish Western American Studies

Science and Mathematics Biology Chemistry Engineering Environmental Science Geology Mathematics Pre-Forestry Pre-Rangeland Ecology Pre-Veterinary Medicine Pre-Wildlife Biology Social Science Anthropology Archaeology Criminal Justice

certificates and Occupational Programs

Accounting Administrative Assistant Automotive Technology Clerk-Typist Creative Writing Diesel and Heavy Equipment Diesel Technology Digital Design Technology Electrical Apprenticeship

Electrical & Instrumentation Technology Electrical Mine Maintenance Emergency Management English as a Second Language Fitness Leadership Human Services Industrial Maintenance Industrial Safety

International Business/ESL Maintenance Mechanic Medical Office Assistant Mining Maintenance Technology Natural Gas Compression Tech. Office Information Systems Oil and Gas Production Technology Power Plant Maintenance Mechanics Surface Maintenance Mechanics

Education-Elementary/Early Childhood Education-Secondary History International Studies Political Science Pre-Law Psychology Social Science Social Work Sociology General Studies

Technical Theatre Underground Maintenance Mechanics Web Site Development Welding Technology Western American Studies

Application for Housing All students interested in on-campus housing must complete this application. Answer all questions. Please type or print clearly.

For Office Use Only WWCC Student ID #

Name: Last (Family)____________________________First (Given)________________________Middle_____________ Former Name(s)_____________________________________________________________________________ Permanent Mailing Address (where mail can always reach you, cannot be the college residence halls): Street________________________________________________________ City__________________


P.O. Box___________________


Phone ( _________ ) ___________________________________

Postal Code______________

Cell (______) ________________________

Email address_______________________________________________________________________________ Date of Birth:

Month _______ / Day _______ / Year _______


  Male    


Enrollment Status (check all that apply): 

New Freshman — no previous college attendance

Transfer Student — list number of credits transferring to WWCC:_______________________________________

Previous attendance at WWCC — list number of credits completed at WWCC:_ ___________________________ Under what name, if different than above?_________________________________________________________ Have you lived in WWCC on-campus housing before?

  Yes  


Planned semester and year of enrollment:   Fall (August) 20_________

  Spring (January) 20_________   Summer (June) 20_________

Major (what area of study are you most interested in?):______________________________________________________

Meal Plan Preference: All freshmen who choose to live on campus and all students living in non-apartment units are required to have at least a 10 Meals per week plan. To be considered a Sophomore for meal plan purposes, the student must fulfill one of the two following criteria: The student must have successfully completed two semesters on campus as a full-time student (12 credits or more per semester), OR the student must have successfully completed at least 32 credit hours on campus as a part-time student. Students transferring to WWCC from another college must have completed at least 32 credit hours. A meal contract will be issued with the official housing assignments packet after a student is accepted for admission.

IHO 07/09

Application continued on reverse side.

Option Requested: Do you require special housing due to a documented disability?

  Yes    No

If yes, please describe:_______________________________________________________________________________ _________________________________________________________________________________________________ Will you receive a special ability grant/scholarship for Athletics or Theatre?   Yes    No If yes, from what team or department?__________________ The following options are available. WWCC will make every effort to place you in the housing unit you prefer. All rooms are non-smoking. Please select your preferences by numbering your 1st and 2nd choice. One Bedroom Apartment: ___ Two Students Two Bedroom Apartment: ___ Four Students Private Bedroom Units (Apartment): ___ Four Students Suite Unit: ___ Two Students - Basement (suite style I) ___ Two Students - Suite Cluster (suite style II) ___ Two Students - Semi-Private Note: All units require a $150 deposit.

Housing assignments are made based on the date the housing deposit is received.

Personal Living Habits (Check all that apply): Are you a:

 Day person

 Night person

I like my room:

 Neat

 "Lived in"

I smoke:

 Yes

 No

My favorite kind of music is:_ __________________________________________________________________________   I am interested in living with an international student:

  Yes

  No

  I am interested in living with the following student(s)______________________________________________________ *Applications and deposits should be submitted at the same time. Special interests, hobbies or concerns:___________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________

"I declare under the penalty of perjury that the information furnished is, to the best of my knowledge and belief, true, correct, and complete." Applicant's Signature____________________________________________________


Financial Guarantee* WWCC is required by the U.S. government to assure that all applicants are able to pay costs of attendance. No acceptance letter or Form I-20 can be issued without satisfactory documentation.

Applicant’s Certification Name:_ ________________________________________________________________________________ I have reviewed and understand the annual expenses for Western Wyoming Community College as an international student. I further understand that these are estimates based upon the average student’s costs and that mine will vary depending upon lab fees, extra tuition charges, and which housing and food options I choose. I guarantee that I will have sufficient funds available to meet the educational expenses I incur at WWCC each semester. I further understand that I must have, at all times, a deposit in my student account equal to the cost of the next semester. Although WWCC international students may apply for scholarships, there is no guarantee that I will receive any financial help from the College. I understand that on campus work study jobs are meant to provide additional spending money. I will not rely on a work study job to pay my semester costs. The funds needed for my education will be provided by: (Check one) _____ My family


My own savings


Other (specify)_________________________________

Signature of Applicant______________________________________________________

Date_ __________________

Guarantor’s Certification Name:_____________________________________________ Relationship to Applicant:_________________________ (1) I understand the expenses for tuition, fees, books, room, board, and health insurance at WWCC. (2) I guarantee that I will provide the applicant with sufficient funds to meet the actual expenses of attendance and that all monetary payments will be made prior to established deadlines. (3) I will provide adequate funds for the applicant’s travel to and from the United States. Signature of Guarantor_ ____________________________________________________

Date_ __________________

Guarantor Information (please print) Name______________________________________________________ Street Address_ _____________________________________________ P.O. Box (if any)______________________________________________ City _________________________________________________ State ________________________________________________ Country ____________________________________________________ Postal Code_________________________________________________ Phone_ ____________________________________________________

*A signed statement from the applicant's or guarantor’s bank verifying that the student has

available a minimum of $15,000 to cover first year costs, travel and personal expenses must accompany this form. ADM 07/09

Health Statement Emergency Treatment Permission is given to any available physician or member of a hospital medical staff to perform emergency treatment and procedures for _______________________________________________________________________(student's name) as he/she deems necessary and to continue treatment and procedures until such time as the undersigned shall dismiss him/her or engage another physician. This permission includes admission to one of the local hospitals if the attending physician deems necessary.

Student's Signature


Parent's or Guardian's Signature (if under 21)



To be completed by the student if 21 years or older - otherwise, to be completed by parent or guardian.


Last (Family)_ _______________________________________________ First (Given)_________________________________________________ Middle_ ____________________________________________________

Is the student undergoing treatment for any disorder?  Yes  No If yes, will this treatment be continued while the student is in College? _  Yes  No Please indicate any drug to which the student is allergic:

Person to be Notified in Emergency: _____________________________





Does the student have limitation on participation in physical education?  Yes  No If yes, degree of limitation:

Family Physician: ______________________________________________


Address:____________________________________________________ ___________________________________________________________ Phone:_____________________________________________________ If the student has any serious disorder, such as asthma, ulcers, epilepsy, please indicate:________________________________________________ ___________________________________________________________ If the student has had major surgery (hernia, appendectomy, etc.) within the past six months, please indicate:________________________

Does the student have any abnormalities which require special facilities and/or special considerations?  Yes  No Has the student any history of mental or emotional disorders?  Yes  No Date of student's most recent MMR (Measles, Mumps and Rubella) inoculation: Month_______ Day_________ Year___________ (Submit note from physician or copy of inoculation card.)

___________________________________________________________ Is the student currently taking prescribed medicine of which the College should be aware?  Yes  No If yes, please indicate which medicines: ____________________________

Signature_ ____________________________________________________ Date__________________________________________________________


TO BE COMPLETED BY A PHYSICIAN This student has been examined by me and found to be in good physical health. Note any special health problems:

 Yes

 No

_____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ Signature of Physician_ __________________________________________________________________ ADM 07/09



Tuition and Other Costs

Approximate Costs for 2009-2010 (2010-2011 costs may be slightly higher): Fall 2009, Spring 2010 Tuition and Fees............................$5,258 Books/Supplies.............................$2,590 Housing (average).........................$2,072 Meal Plan (18 meals/week)...........$1,987 Medical Insurance............................$650 Total . ...........................................$12,557 per semester Deposit: Students must submit a $6,300 deposit for the first .semester costs. The deposit is due upon arrival and check-in on campus. Payment may be made by international money order, traveler's checks, checks drawn on a U.S. bank, or direct wire transfer. Students should budget additional funds for incidentals and personal expenses including meals off campus, laundry and entertainment. WWCC estimates a minimum of $500 for the academic year and $1000 for summer stay (optional). Contact Admissions with questions and for direct wire transfer information.

Western Wyoming Community College is an Affirmative Action/Equal Opportunity institution and as such, does not discriminate on the basis of race, color, national origin, sex, age, religion, disability status, disabled veteran, or veteran of the Vietnam, Gulf, or any other era in admission or access to, or treatment or employment in, its educational programs or activities. Inquiries concerning Title VI, Title IX, Section 504, ADA, and other related laws may be referred to the V.P. for Administrative Services, WWCC Administrative Offices, P.O. Box 428, Rock Springs, Wyoming 82902-0428, (307) 382-1609; or Office for Civil Rights, Denver Office, U.S. Department of Education, Cesar E. Chavez Memorial Building, Suite 310, 1244 Spear Avenue Blvd., Denver, CO 80204-3582, (303) 844-5695, FAX (303) 844-4303 or TDD (303) 844-3417 or the Wyoming Labor Standards Department, 1510 East Pershing Blvd., Cheyenne, Wyoming 82002 (307) 777-7261.

Return application to:

Admissions 2500 College Drive Rock Springs WY 82901 U.S.A. Email: Website: Telephone: 307-382-1633 Fax: 307-382-1636

International Application  
International Application  

International Application for Western Wyoming Community College.